title: Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure.
abstract: OBJECTIVE
  Continuous positive airway pressure (CPAP) has been used to treat patients with chronic heart failure (CHF) and sleep-disordered breathing (SDB). CPAP treatment in severe CHF with concomitant SDB and atrial fibrillation has been linked to impairment of cardiac output (CO) as a potential cause for adverse outcome. The aim of the present study was to test whether incremental CPAP application in awake CHF patients with SDB, with and without atrial fibrillation, induces acute alterations of blood pressure (BP), heart rate (HR) and CO.
  
  
  METHODS
  During daytime, we applied incremental CPAP (4-10 cmH2O) in 37 stable patients with CHF and SDB. BP and HR were assessed after each 1 cmH2O CPAP increase in 5-min intervals in the entire sample, and CO was assessed at one centre (n = 11).
  
  
  RESULTS
  Neither mean BP, HR nor CO changed significantly with incremental CPAP (at 0 and 10 cmH2O: 85 ± 2 and 84 ± 2 mm Hg, P = 1.0, 63 ± 1 to 61 ± 2 b.p.m., P = 0.88 and 2.03 ± 0.5 and 2.35 ± 0.8 L/min/m2 , P = 0.92, respectively). No significant differences in maximum BP drop or HR drop between patients with sinus rhythm and atrial fibrillation were found. In 1 of 37 patients, a prespecified event of haemodynamic compromise (drop of mean BP >15 mm Hg) without clinical signs occurred.
  
  
  CONCLUSIONS
  These results contribute to the evidence that CPAP does not cause haemodynamic compromise in the vast majority of normotensive CHF patients with SDB.
authors.affiliation: Department of Internal Medicine II, Pneumology, University Hospital Regensburg, Regensburg.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schroll
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sériès
authors.forename: Keir
authors.initials: K
authors.lastname: Lewis
authors.forename: Amit
authors.initials: A
authors.lastname: Benjamin
authors.forename: Pierre
authors.initials: P
authors.lastname: Escourrou
authors.forename: Ruth
authors.initials: R
authors.lastname: Luigart
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeifer
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology*; D055815:Young Adult
keywords: blood pressure; heart failure; heart rate; positive airway pressure; sleep apnoea